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claims specialist

TEEMA

<div>Job Summary
Workers Compensation Claims Examiner III
TeemaGroup
Full-time- CONTRACT 3-4 months could be longer
In-Office | Irving, TX, United States<ul><li> 
POSITION SUMMARY: Under minimal supervision manages all aspects of indemnity claims handling from inception to conclusion within established authority and guidelines. 
 
This position requires considerable interaction with clients, claimants on the phone, and with management, other Claims Examiners, and other TRISTAR staff in the office; therefore consistently being at work in the office, in a timely manner, is inherently required of this position. 
 
DUTIES AND RESPONSIBILITIES: 
Handle loss time Workers&rsquo; Compensation claims in TX Office&mdash;Texas Jurisdiction 
Handle claims as per Best Practices, SOC 1 and client Claims Handling Instructions 
The ability to prepare a formal captioned report on claims meeting client requirements 
Well organized and CAN-DO attitude. 
Ability to effectively communicate in a professional manner 
Provide great customer service 
Assist employers and their employees understand the Workers&rsquo; Compensation process 
Investigate, evaluate, determine compensability, pay benefits timely as required and 
comply with all statutory requirements 
A good sense of urgency 
Ability to get along well with others with a positive attitude 
 
EQUIPMENT OPERATED/USED: Computer, 10-key, fax machine, copier, printer, and other office equipment. 
 
SPECIAL EQUIPMENT OR CLOTHING: Follow company dress code 
 
QUALIFICATIONS REQUIRED: 
 
Education/Experience: High School Diploma or GED required; Bachelor&rsquo;s degree in related field (preferred); five (5) or more years related experience; or equivalent combination of education and experience. 
 
Other Qualifications: 
Workers&rsquo; Compensation Adjusters License for the State of Texas</li></ul>
QUALIFICATIONS REQUIRED
Education &amp; Experience<ul><li>Claims Examiner II:</li><li>Bachelor&rsquo;s degree in a related field (preferred)</li><li>Claims Examiner III:</li><li>Minimum 5+ years of progressive workers&rsquo; compensation claims experience</li><li>Demonstrated experience handling complex and litigated indemnity claims</li></ul>
#Workwolf</div>

Workers Compensation Claims Examiner III

Cala Sourcing Solutions LLC

<div><h3 class="jobSectionHeader">Workers&rsquo; Compensation Claims Examiner III (Contract)</h3>
Please no 3rd party recruiters, or C2C.
Location: Irving, TX 
Schedule: On-site | Monday&ndash;Friday (5 days/week) - only local candidates will be considered 
Pay Rate: $36.53 &ndash; $38.46 per hour 
Contract Length: 3&ndash;4 months (with potential extension)<h4 class="jobSectionHeader">
About the Role</h4>
We&rsquo;re looking for a seasoned Workers&rsquo; Compensation Claims Examiner III to step into a fast-paced, high-volume environment and take ownership of Texas loss-time claims from start to finish. This role is ideal for an experienced examiner who is confident working independently, thrives in an in-office setting, and understands the importance of accuracy, urgency, and strong communication.
This is a fully on-site position in Irving, TX. Daily in-person collaboration with colleagues and stakeholders is a core part of the role&mdash;remote or hybrid work is not available.<h4 class="jobSectionHeader">
What You&rsquo;ll Be Doing</h4><ul><li>
Handle Texas Workers&rsquo; Compensation indemnity claims from initial intake through resolution</li><li>
Analyze coverage, investigate facts, and make compensability determinations in compliance with Texas statutes</li><li>
Administer indemnity and medical benefits within assigned authority levels</li><li>
Apply internal best practices and client-specific handling guidelines consistently</li><li>
Prepare and maintain detailed, captioned claim reports and documentation</li><li>
Serve as a key point of contact for claimants, employers, attorneys, and internal partners</li><li>
Clearly explain the claims process to employers and injured workers, setting expectations throughout the claim lifecycle</li><li>
Maintain accurate, timely claim files while balancing multiple deadlines</li><li>
Deliver a high level of customer service in a regulated, deadline-driven environment</li></ul><h4 class="jobSectionHeader">
What We&rsquo;re Looking For</h4><ul><li>
Active Texas Workers&rsquo; Compensation Adjuster License (required)</li><li>
5+ years of hands-on Texas Workers&rsquo; Compensation claims experience</li><li>
Prior experience handling public entity and First Responder claims</li><li>
Strong working knowledge of Texas Workers&rsquo; Compensation laws and regulations</li><li>
Excellent written and verbal communication skills</li><li>
Ability to manage a full caseload with minimal supervision</li><li>
High School Diploma or GED required</li><li>
Bachelor&rsquo;s degree in a related field preferred</li></ul><h4 class="jobSectionHeader">
Work Environment &amp; Expectations</h4><ul><li>
100% on-site role in a professional office setting</li><li>
Frequent interaction with internal teams and external stakeholders</li><li>
Use of standard office equipment and claims management systems</li><li>
Consistent, full-time in-office attendance required</li></ul><h4 class="jobSectionHeader">
Additional Requirements</h4><ul><li>
Ability to pass a background check and drug screening</li><li>
Authorization to work in the United States</li></ul>
#Workwolf</div>

Worker's comp/Claims examiner III

TEEMA Group

<div><h3 class="jobSectionHeader">Role Summary</h3>
The Workers&rsquo; Compensation Claims Supervisor is a key leadership role responsible for guiding and overseeing a high-performing claims team in a fast-paced, compliance-focused environment. This position offers the opportunity to combine deep technical expertise in Texas workers&rsquo; compensation with hands-on leadership, mentorship, and client engagement. The Supervisor ensures accurate claims handling, regulatory compliance, exceptional service delivery, and continuous professional development of staff, while serving as a trusted resource for clients and internal partners.
This is an ideal opportunity for an experienced claims leader who thrives in an in-office setting, values accountability and collaboration, and enjoys driving both operational excellence and team success.
<h3 class="jobSectionHeader">Key Duties &amp; Responsibilities</h3><ul><li>
Supervise, mentor, and support Claims Examiners, Claims Assistants, and administrative staff</li><li>
Monitor attendance, performance, evaluations, and address disciplinary matters as needed</li><li>
Review claims activity, including initial reviews, ongoing case management, delays, and denials</li><li>
Approve reserve changes up to $250,000 and payments up to $10,000 in accordance with internal guidelines</li><li>
Conduct comprehensive file reviews to ensure compliance with Texas workers&rsquo; compensation laws, client requirements, and internal procedures</li><li>
Coordinate and lead training sessions related to regulatory updates, internal policies, and best practices</li><li>
Ensure caseloads are appropriately staffed, balanced, and managed efficiently</li><li>
Approve priority payments and sign checks as required</li><li>
Respond professionally and promptly to claimant, vendor, and client inquiries or concerns</li><li>
Monitor vendor performance and recommend or implement panel adjustments as necessary</li><li>
Ensure all client servicing instructions are consistently followed</li><li>
Provide coverage for claims examiners during absences or vacancies</li><li>
Prepare, review, and evaluate monthly client reports</li><li>
Facilitate and participate in internal and external audits</li><li>
Conduct and document educational and training sessions for internal teams and external stakeholders</li><li>
Attend client file reviews and meetings as needed</li><li>
Collaborate with leadership and sales/service teams on RFPs and client service initiatives</li><li>
Adhere to Supervisor Best Practice Guidelines</li><li>
Perform additional duties as assigned to support operational and organizational goals</li></ul><h3 class="jobSectionHeader">
Required Qualifications</h3><ul><li>
High School Diploma or GED</li><li>
Minimum of 5 years of supervisory experience within workers&rsquo; compensation claims</li><li>
Active Texas Adjuster&rsquo;s License</li><li>
Strong working knowledge of Texas workers&rsquo; compensation statutes and regulations</li><li>
Solid understanding of medical terminology</li><li>
Proven experience supervising claims staff in a high-volume environment</li></ul><h3 class="jobSectionHeader">
Desired Qualifications</h3><ul><li>
Bachelor&rsquo;s degree in a related field</li><li>
Experience handling Texas public entity and school district claims (highly preferred)</li><li>
Strong analytical and problem-solving capabilities</li><li>
Ability to manage diary systems, prioritize workload, and meet strict deadlines</li><li>
Excellent written and verbal communication skills</li><li>
Ability to clearly explain complex claims information to claimants, clients, and staff</li><li>
Proficiency in Microsoft Word and Excel</li><li>
Demonstrated ability to manage and mentor employees with varying experience levels</li><li>
Strong interpersonal, leadership, and coaching skills</li><li>
Ability to manage stress, multitask effectively, and maintain focus in a deadline-driven environment</li><li>
Positive, professional attitude with a strong sense of urgency and accountability</li></ul><h3 class="jobSectionHeader">
About the Organization</h3>
This opportunity is with a well-established organization specializing in workers&rsquo; compensation and claims administration services. The organization is committed to regulatory excellence, client satisfaction, and fostering a collaborative, professional work environment that supports growth, leadership development, and long-term career success.
<h3 class="jobSectionHeader">Location &amp; Work Type</h3><ul><li>
Location: Irving, Texas</li><li>
Work Type: On-site, in-office role</li></ul>
#Workwolf</div>

Workers’ Compensation Claims Supervisor

<div>We are seeking an experienced Texas Workers&rsquo; Compensation Claims Adjuster to join our team at our Irving, TX office. This role is primarily in-office, five days per week, with limited hybrid flexibility considered only for highly experienced adjusters who live farther from the office and have a proven ability to independently manage Texas claims.
This position requires strong technical knowledge of Texas Workers&rsquo; Compensation laws, confidence attending hearings, and the ability to manage a full caseload with minimal oversight.<h3 class="jobSectionHeader">
Key Responsibilities</h3><ul><li>
Manage a full caseload of Texas Workers&rsquo; Compensation claims from inception through resolution</li><li>
Investigate claims, analyze coverage, determine compensability, and establish reserves</li><li>
Communicate effectively with injured workers, employers, medical providers, and legal representatives</li><li>
Prepare for and attend Workers&rsquo; Compensation hearings as required</li><li>
Ensure compliance with Texas Workers&rsquo; Compensation laws, regulations, and internal guidelines</li><li>
Maintain accurate and timely documentation within claims management systems</li><li>
Provide high-quality customer service while balancing cost containment and fair claim resolution</li></ul><h3 class="jobSectionHeader">
Work Schedule &amp; Location</h3><ul><li>
Primary expectation: In-office, 5 days per week</li><li>
Hybrid consideration may be given based on:<ul><li>
Distance from the Irving office</li><li>
Depth of Texas Workers&rsquo; Comp experience</li><li>
Demonstrated ability to manage claims independently</li></ul></li><li>
Candidates commuting 1 hour or more may be considered for hybrid only if experience level supports it</li></ul><h3 class="jobSectionHeader">
Required Qualifications</h3><ul><li>
Active Texas Workers&rsquo; Compensation Adjuster License<ul><li>
Must provide license number and expiration date</li></ul></li><li>
Minimum 3 years of experience handling Texas Workers&rsquo; Compensation claims<ul><li>
5+ years strongly preferred</li></ul></li><li>
Proven experience managing hearings and complex claims</li><li>
Strong written, verbal, and organizational skills</li><li>
Ability to work effectively in an in-office team environment</li></ul>
If you would like to apply email your resume
mpalkin@teemagroup.com
#Workwolf</div>

Workers’ Compensation Claims Adjuster (Texas)

CHRISTUS Health

<div>Description 
Summary:
The associate is responsible for the duties and services that are of a support nature to the Revenue Cycle division of CHRISTUS Health. The associate ensures that all processes are performed in a timely and efficient manner. The primary purpose of these positions is to ensure account resolution and reconciliation of outstanding balances for CHRISTUS Health patient accounts. The Job works in a cooperative team environment to provide value to internal and external customers.
 
The associate carries out his/her duties by adhering to the highest standards of ethical and moral conduct, acts in the best interest of CHRISTUS Health, and fully supports CHRISTUS Health's Mission, Philosophy, and core values of Dignity, Integrity, Compassion, Excellence and Stewardship.
Responsibilities: 
<ul><li>Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders.
</li><li>Performs Revenue Cycle functions in a manner that meets or exceeds CHRISTUS Health's key performance metrics.
</li><li>Ensures PFS departmental quality and productivity standards are met.
</li><li>Collects and provides patient and payor information to facilitate account resolution.
</li><li>Maintains an active working knowledge of all Government Mandated Regulations as it pertains to claims submission. Responsible to perform the necessary research in order to determine proper governmental requirements prior to claims submission.
</li><li>Responds to all types of account inquires through written, verbal, or electronic correspondence.
</li><li>Maintains payor-specific knowledge of insurance and self-pay billing and follow-up guidelines and regulations for third-party payers. Maintains working knowledge of all functions within the Revenue Cycle.
</li><li>Responsible for professional and effective written and verbal communication with both internal and external customers in order to resolve outstanding questions for account resolution.
</li><li>Meets or exceeds customer expectations and requirements, and gains customer trust and respect.
</li><li>Compliant with all CHRISTUS Health, payer, and government regulations.
</li><li>Exhibits a strong working knowledge of CPT, HCPCS, and ICD-10 coding regulations and guidelines.
</li><li>Appropriately documents patient accounting host system or other systems utilized by PFS in accordance with policy and procedures.
</li><li>Provide continuous updates and information to the PFS Leadership Team regarding errors, issues, and trends related to activities affecting productivity, reimbursement, payment delays, and/or patient experience.
</li><li>Professional and effective written and verbal communication required.
</li></ul><ul><li>Billing
</li><li>Review and work on claim edits.
</li><li>Works payor rejected claims for resubmission.
</li><li>Works reports and billing requests.
</li><li>Demonstrates strong knowledge of standard bill forms and filing requirements.
</li><li>Exhibits and understanding of electronic claims editing and submission capabilities.
</li><li>Correct claims in RTP status in the designated claim system per Medicare guidelines.
</li><li>Maintains an active knowledge of all governmental agency requirements and updates.
</li></ul><ul><li>Collections
</li><li>Collect balances due from payors ensuring proper reimbursement for all services.
</li><li>Identifies and forwards proper account denial information to the designated departmental liaison. Dedicated efforts to ensure a proper denial resolution and timely turnaround.
</li><li>Maintain an active knowledge of all governmental agency requirements and updates.
</li><li>Works collector queue daily utilizing appropriate collection system and reports.
</li><li>Demonstrates knowledge of standard bill forms and filing requirements.
</li><li>Identify and resolve underpayments with the appropriate follow-up activities within payor timely guidelines.
</li><li>Identify and resolve credit balances with the appropriate follow-up activities within payor timely guidelines.
</li><li>Identify and communicate trends impacting account resolution.
</li><li>Corrects claims in RTP status in the designated claim system per Medicare guidelines.
</li><li>Initiates Medicare Redetermination, Reopening and/or Reconsideration as needed.
</li><li>Working knowledge of the CMS 838 credit balance report.
</li></ul><ul><li>Vendor Coordinator
</li><li>Acts as liaison between external vendors and Revenue Cycle departments to monitor external vendor activities and ensures accounts placed for collection are received timely and acknowledged as received by the vendor.
</li><li>Manages account transfers between CHRISTUS Health and the various contracted vendors.
</li><li>Coordinates with Revenue Cycle Managers (Collections, Billing, Cash Applications, etc.) to review of selected accounts prior to transfer and placement with an external third party.
</li><li>Ensures accounts deemed as closed or uncollectible by the vendors are properly reflected in applicable AR systems.
</li><li>Maintains department reports measuring agency performance, which includes account placements, collections, returns, and performance metrics.
</li><li>Advises vendors of CHRISTUS Health billing and collection procedures and ensures accounts identified with third-party coverage are properly billed by the entities as requested by the vendor.
</li><li>Audits all vendor remittances and ensures all fees billed to CHRISTUS Health are in accordance with the contract and include supporting documentation of payments posted to the account on the patient accounting systems.
</li><li>Recalls accounts incorrectly placed and/or as requested by Revenue Cycle Managers with the external vendor and returns accounts to open receivables as appropriate.
</li><li>Creates tools, reports, or documentation that enables Revenue Cycle Leadership to understand, manage, and measure their vendor's performance and to prioritize important relationships.
</li><li>Performs account reconciliation between CHRISTUS Health system and vendor system.</li></ul>
Job Requirements: 
Education/Skills
<ul><li>HS Diploma or equivalent years of experience required.
</li><li>Post HS education preferred.
</li></ul>Experience
<ul><li>1-3 years of experience preferred.
</li><li>Experience working within a multi-facility hospital business office environment preferred.
</li><li>College education, previous Insurance Company claims experience, and/or health care billing trade school education may be considered in lieu of formal hospital experience.
</li><li>Experience working with inpatient and outpatient billing requirements of UB-04 and HCFA 1500 billing forms preferred.
</li><li>Experience with Medicare &amp; Medicaid billing processes and regulations preferred.
</li><li>Understanding of Medicare language.
</li><li>Knowledge in locating and referencing CMS and/or Medicare Regulations preferred.
</li></ul>Licenses, Registrations, or Certifications
<ul><li>None required.</li></ul> 

Work Schedule: 
8AM - 5PM Monday-Friday
Work Type: 
Full Time</div>

Patient Financial Specialist - Patient Financial Services

RailPros

<div>Who We Are:
RailPros is the premier provider of engineering and diversified safety services to America's rail and transit industry. Driven by a passion for our people, clients, and communities, we are committed to solving our customers' challenges and earning their trust through teamwork, continuous improvement, and service excellence. As a people first organization, we prioritize the safety, well being, and growth of our employees, fostering a culture of caring and support. We believe that when our people thrive, our company thrives.
Our mission is to enhance mobility, safety, and quality of life for residents, passengers, and partner companies. We do more than just provide services; we are constantly innovating and staying informed of industry developments to help our customers succeed. Join us in our shared goal of keeping America moving and ensuring customer satisfaction in an environment where your contributions are valued and your growth is encouraged. Apply now and become a part of our exciting journey!
Job Summary:
The Human Resources Specialist plays a key role in the HR department by serving as a point of contact for employees and managers regarding HR matters and providing comprehensive support in various HR functions. This position is responsible for a wide range of tasks, including onboarding, offboarding, employee relations, compliance, and other team projects, contributing to the development and maintenance of a positive and productive work environment.
Essential Duties &amp; Responsibilities:<ul><li>
Facilitate a seamless transition for new hires by managing onboarding processes such as drug/alcohol testing, background check, training, employment paperwork, IT equipment, System accesses, and other tasks required to ensure a successful on boarding are completed accurately and timely</li><li>
Conduct orientation sessions in person or via Teams</li><li>
Flexible to conduct orientations in from early morning to early evening hours and/or weekends as needed to meet the demands of our distributed workforce</li><li>
Process promotions and transfers, updating relevant systems to reflect changes</li><li>
Work closely with departments such as IT, Accounting, and Safety to enhance the onboarding red carpet experience for new employees</li><li>
Provide guidance to employees on HR policies and procedures</li><li>
Maintain direct communication with both internal teams and external partners</li><li>
Handle incoming and outgoing mail, ensuring timely distribution of badges and HR related correspondence</li><li>
Follow termination procedures, completing offboarding tasks</li><li>
Assist with conducting exit and stay interviews to monitor employee feedback</li><li>
Monitor and respond to inquiries in the internal ticketing queue</li><li>
Review and update standard operating procedures (SOPs) for accuracy</li><li>
Respond to multistate unemployment claims and manage appeal proceedings</li><li>
Process requests for employment verification in accordance with company policies</li><li>
Track and maintain annual trainings requirements</li><li>
Participate in team projects as needed</li><li>
Identify training needs and assist in the development of employee training programs</li><li>
Maintain accurate and confidential employee records and HR files</li><li>
Assist in creating, implementing, and communicating HR policies and procedures</li><li>
Provide support to HR Manager and other staff</li><li>
Ensure compliance with federal, state, and local employment laws and regulations</li><li>
Lead project meetings and makes presentations</li><li>
Represent the organization and maintain liaison with individuals and related organizations</li><li>
Up to 10% travel as required for in person orientations; in state or out of state</li><li>
Travel as needed (approximately 10%) within the U.S. to attend orientation meetings</li><li>
This position may require travel to RailPros headquarters, field offices or client offices, work sites and other project related locations</li><li>
Contribute to a positive, inclusive, and respectful workplace culture, free from behaviors that undermine morale, productivity, or organizational values</li><li>
Uphold the organization&rsquo;s standards of integrity, accountability, and respect in all duties and interactions</li><li>
Adhere to all company policies, procedures, and applicable laws and regulation</li><li>
Other duties as assigned or required to meet the business needs</li></ul>
Knowledge Skills and Abilities:<ul><li>
Proficient with electronic communications including email and text as well as standard office applications (i.e., Microsoft Office Suite)</li><li>
Advanced oral and written communication skills for effective employee relations at all levels using a customer service approach</li><li>
Applying logical thought processes and organizing resources in order to solve issues and meet commitments</li><li>
Making decisions and seizing opportunities in the context of RailPros business objectives</li><li>
Satisfying internal and external customer expectations and developing customer partnerships</li><li>
Partnering effectively with others in order to achieve results</li><li>
Strong presentation skills including demonstrated proficiency with presentations in front of large groups</li><li>
Strong organizational and analytical skills</li><li>
Basic knowledge of HR concepts with emphasis on staffing processes, internal HR policies, employment law and interviewing techniques or equivalent demonstrated skills and abilities</li><li>
Demonstrated personal computer skills using Microsoft Office, Internet software, and human resources information system (HRIS) and applicant tracking system (ATS) applications</li></ul>
Required Education and Experience:<ul><li>
Associate&rsquo;s degree in HR, Business, or related field</li><li>
3 years&rsquo; experience in human resources, including onboarding/offboarding, employee relations, unemployment claims, and compliance</li></ul>
Additional Qualifications, Certifications, etc.:<ul><li>
HR certification preferred</li></ul>
Why RailPros? Build Your Career Where Culture Leads The Way<ul><li>
A People First Culture (Caring): At RailPros, you&rsquo;re more than an employee; you&rsquo;re part of a team driven by genuine care and respect. Our Align29 pillar of Caring reflects our deep commitment to supporting your growth, well being, and success every step of the way.</li><li>
A Workplace Where Your Voice Matters (Sharing): Our Sharing culture encourages transparency, active dialogue, and collaboration across every level of the company.</li><li>
A Company Invested in Your Growth (Progress): Through continuous improvement of our systems, processes, and operations, our Progress pillar ensures you have the tools and support to excel.</li><li>
An Innovative, Industry Leading Environment (Innovation): Our Innovation pillar fuels creative problem solving, modern technology adoption, and breakthrough thinking that positions RailPros as a leader in the rail and transit space.</li></ul>
Benefits &amp; Perks:<ul><li>
Comprehensive Health Insurance: Includes medical, dental, and vision coverage.</li><li>
Additional Coverage Plans: Accident plan, critical illness plan, and hospital indemnity with employee to family coverage.</li><li>
Legal Shield, ID Shield, Pet Insurance: Added protection for you...and your pets.</li><li>
Life &amp; Disability Insurance: Employer provided coverage with additional voluntary options available.</li><li>
Retirement Savings: 401(k) plan with employer match includes pre and post deduction options.</li><li>
Paid Time Off (PTO): With carryover each year.</li><li>
Paid Holidays: For full time employees.</li><li>
Wellness Programs: Access to wellness initiatives and resources.</li><li>
Discount Programs: Exclusive discounts on products and services.</li><li>
Company Merchandise Allowance: Company funded allowance for our online store.</li><li>
Health Savings Accounts (HSA): With employer match.</li><li>
Health Reimbursement Arrangement (HRA): Employer funded.</li><li>
Flexible Spending Accounts (FSA): For dependent care expenses.</li><li>
Employee Assistance Programs (EAP): Support for personal and professional challenges.</li><li>
Professional Development: Opportunities for training and career growth.</li><li>
Balanced Work Environment: A culture that respects boundaries so employees can recharge and bring their best selves to work.</li><li>
Tuition Reimbursement: Support for continued education or professional development.</li><li>
Professional &amp; Career Growth: Through mentorship, continuous training, career path partnerships, goal setting, and succession planning.</li><li>
Culture &amp; Recognition: Employee spotlights, annual Service Excellence Awards, alignment committee, philanthropy opportunities, company events, monthly new hire calls, monthly newsletters, feedback surveys, and quarterly town halls.</li></ul>
Choose a career where your work truly matters. At RailPros, you&rsquo;ll be part of a stable, growing industry and a team driven by strong core values. We collaborate, innovate, and stay ahead of industry changes to deliver exceptional service to our clients. Our culture is built on trust, continuous improvement, and practical problem solving.
If you&rsquo;re passionate about making an impact and want to grow with a dedicated, supportive team, join us and contribute to our success.
Equal Employment Opportunity (EEO)
RailPros provides equal employment opportunities to all qualified candidates, regardless of race, religion, color, national origin, citizenship, sex, sexual orientation, gender identity, age, veteran status, disability, genetic information, or any other protected characteristic. We are committed to making reasonable accommodations for known physical or mental limitations unless doing so would impose undue hardship. For accommodation requests, contact peopleoperations@railpros.com.</div>

Human Resources Specialist

<div>Description 
Summary:
The associate is responsible for the duties and services that are of a support nature to the Revenue Cycle division of CHRISTUS Health. The associate ensures that all processes are performed in a timely and efficient manner. The primary purpose of this Job is to ensure account resolution and reconciliation of outstanding balances for CHRISTUS Health patient accounts. The Job works in a cooperative team environment to provide value to internal and external customers.
 
The associate carries out his/her duties by adhering to the highest standards of ethical and moral conduct, acts in the best interest of CHRISTUS Health, and fully supports CHRISTUS Health's Mission, Philosophy, and core values of Dignity, Integrity, Compassion, Excellence, and Stewardship.
Responsibilities: 
<ul><li>Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders.
</li><li>Performs Revenue Cycle functions in a manner that meets or exceeds CHRISTUS Health's key performance metrics.
</li><li>Ensures PFS departmental quality and productivity standards are met.
</li><li>Collects and provides patient and payor information to facilitate account resolution.
</li><li>Responds to all types of account inquiries through written, verbal, or electronic correspondence.
</li><li>Maintains payor-specific knowledge of insurance and self-pay billing and follow-up guidelines and regulations for third-party payers. Maintains working knowledge of all functions within the Revenue Cycle.
</li><li>Responsible for professional and effective written and verbal communication with both internal and external customers in order to resolve outstanding questions for account resolution.
</li><li>Meets or exceeds customer expectations and requirements, and gains customer trust and respect.
</li><li>Compliant with all CHRISTUS Health, payer, and government regulations.
</li><li>Exhibits a strong working knowledge of CPT, HCPCS, and ICD-10 coding regulations and guidelines.
</li><li>Appropriately documents patient accounting host system or other systems utilized by PFS in accordance with policy and procedures.
</li><li>Provide continuous updates and information to the PFS Leadership Team regarding errors, issues, and trends related to activities affecting productivity, reimbursement, payment delays, and/or patient experience.
</li><li>Must have professional and effective written and verbal communication.
</li></ul><ul><li>Billing
</li><li>Review and work on claim edits.
</li><li>Works payor rejected claims for resubmission.
</li><li>Works reports and billing requests.
</li><li>Demonstrates strong knowledge of standard bill forms and filing requirements.
</li><li>Exhibits and understanding of electronic claims editing and submission capabilities.
</li></ul><ul><li>Collections
</li><li>Collect balances due from payors ensuring proper reimbursement for all services.
</li><li>Identifies and forwards proper account denial information to the designated departmental liaison. Dedicated efforts to ensure a proper denial resolution and timely turnaround.
</li><li>Maintain an active knowledge of all collection requirements by payors.
</li><li>Works collector queue daily utilizing appropriate collection system and reports.
</li><li>Demonstrates knowledge of standard bill forms and filing requirements.
</li><li>Identify and resolve underpayments with the appropriate follow-up activities within payor timely guidelines.
</li><li>Identify and resolve credit balances with the appropriate follow-up activities within payor timely guidelines.
</li><li>Identify and communicate trends impacting account resolution.
</li></ul><ul><li>Cash Reconciliation
</li><li>Ensures all payments are retrieved and posted accurately and timely through reconciliation of patient accounting system and bank statement.
</li><li>Researches submitted cash payments by verifying patient account numbers and appropriate facilities.
</li><li>Monitor and performs cash reconciliation to identify cash posting errors and ensures all receipts are applied and reconciles to daily bank deposit and monthly bank statements.
</li><li>Review and post cash corrections, including resolving patient complaints and inquiries from PFS, Finance, Facilities, and Vendor Partners.
</li><li>Resolve and Research unapplied cash, including continuous follow-up until payment identification is made for application of payment or refund.</li></ul>
Job Requirements: 
Education/Skills
<ul><li>HS Diploma or equivalent years of experience required.
</li><li>Post HS education preferred.
</li></ul>Experience
<ul><li>3-5 years of experience preferred.
</li><li>Experience working within a multi-facility hospital business office environment preferred.
</li><li>College education, previous Insurance Company claims experience and/or health care billing trade school education may be considered in lieu of formal hospital experience.
</li><li>Experience working with inpatient and outpatient billing requirements of UB-04 and HCFA 1500 billing forms preferred.
</li></ul>Licenses, Registrations, or Certifications
<ul><li>None required.</li></ul> 

Work Schedule: 
8AM - 5PM Monday-Friday
Work Type: 
Full Time</div>

Patient Financial Representative Senior - Patient Financial Services

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